Detection and management of acute HIV infections in patients with sexually transmitted infections: a window of opportunity for HIV prevention within South Africa?

Abstract

Patients with acute human immunodeficiency virus (HIV) infection are highly infectious to their uninfected sexual partners. The level of this infectiousness is thought to be as much as 26 times greater than that observed during chronic HIV infection, and may be further elevated in patients with coexisting sexually transmitted infections (STI). The sexual partners of acute HIV infection patients with STIs may be more vulnerable to HIV acquisition, because of genital tract inflammation and ulcerations. Data from international and South African studies demonstrate that STI patients are a high-risk population for acute HIV infection. However, most acute HIV infection cases remain clinically undiagnosed, and scoring algorithms offer little assistance to physicians and nurses in terms of improving their diagnostic ability. Laboratory testing of blood specimens remains the only effective means of diagnosis. Laboratory costs have been reduced through the use of pooling strategies for HIV nucleic acid detection, and algorithms that incorporate dual HIV rapid tests and ultrasensitive p24 antigen assays. The availability of these diagnostic tools and antiretroviral drugs means that there is a window of opportunity to enhance HIV prevention activities in South Africa. This can be achieved by screening STI patients for acute HIV infection, in order to initiate appropriate medical management, risk reduction counselling and partner notification.